Consensus conference statement on fluorescence-guided surgery (FGS) ESSO course on fluorescence-guided surgery

European Journal of Surgical Oncology, vol. 50, pp. 107317

Abstract

BACKGROUND: Fluorescence-guided surgery (FGS) has emerged as an innovative technique with promising applications in various surgical specialties. However, clinical implementation is hampered by limited availability of evidence-based reference work supporting the translation towards standard-of-care use in surgical practice. Therefore, we developed a consensus statement on current applications of FGS. METHODS: During an international FGS course, participants anonymously voted on 36 statements. Consensus was defined as agreement ≥70% with participation grade of ≥80%. All participants of the questionnaire were stratified for user and handling experience within five domains of applicability (lymphatics & lymph node imaging; tissue perfusion; biliary anatomy and urinary tracts; tumor imaging in colorectal, HPB, and endocrine surgery, and quantification and (tumor-) targeted imaging). Results were pooled to determine consensus for each statement within the respective sections based on the degree of agreement. RESULTS: In total 43/52 (81%) course participants were eligible as voting members for consensus, comprising the expert panel (n = 12) and trained users (n = 31). Consensus was achieved in 17 out of 36 (45%) statements with highest level of agreement for application of FGS in tissue perfusion and biliary/urinary tract visualization (71% and 67%, respectively) and lowest within the tumor imaging section (0%). CONCLUSIONS: FGS is currently established for tissue perfusion and vital structure imaging. Lymphatics & lymph node imaging in breast cancer and melanoma are evolving, and tumor tissue imaging holds promise in early-phase trials. Quantification and (tumor-)targeted imaging are advancing toward clinical validation. Additional research is needed for tumor imaging due to a lack of consensus.

Authors 16

1. Martijn A. van Dam Aachen Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery, Leiden University Medical Center, the Netherlands

2. Okker D. Bijlstra Aachen Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Surgery, Leiden University Medical Center, the Netherlands; Department of Surgery, Amsterdam University Medical Centers, the Netherlands

   Department of Surgery, Amsterdam University Medical Centers, the Netherlands

   Department of Surgery, Leiden University Medical Center, the Netherlands

3. Robin A. Faber Aachen Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery, Leiden University Medical Center, the Netherlands

4. Mats I. Warmerdam Aachen Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Surgery, Leiden University Medical Center, the Netherlands

5. Michael Patrick Achiam

   Copenhagen University Hospital · Rigshospitalet

   Affiliation as printed

   Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Denmark

6. Luigi Boni

   Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

   Affiliation as printed

   Department of General and Minimally Invasive Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy

7. Ronan A. Cahill

   University College Dublin

   Affiliation as printed

   Department of Surgery, UCD Centre for Precision Surgery, University College Dublin, Ireland

8. Manish Chand

   University College London

   Affiliation as printed

   Division of Surgery and Interventional Sciences, University College London, London, UK

9. Michèle Diana

   Institut de Recherche contre les Cancers de l’Appareil Digestif

   Affiliation as printed

   IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France

10. Sylvain Gioux

    Intuitive Surgical (Switzerland)

    Affiliation as printed

    Intuitive Surgical, Aubonne, Switzerland

11. Schelto Kruijff

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Surgical Oncology, University Medical Center Groningen, the Netherlands; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands

    Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, the Netherlands

12. Joost R. van der Vorst Aachen Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery, Leiden University Medical Center, the Netherlands

13. Raul Jacobo Rosenthal

    Cleveland Clinic Florida

    Affiliation as printed

    Cleveland Clinic Florida, Weston, FL, USA

14. Karol Połom

    Greater Poland Cancer Center

    Affiliation as printed

    The Academy of Applied Medical and Social Sciences, Lotnicza 2, Elblag, Poland; Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Garbary 15, Poznan, Poland

    Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, Garbary 15, Poznan, Poland

    The Academy of Applied Medical and Social Sciences, Lotnicza 2, Elblag, Poland

15. Alexander L. Vahrmeijer Aachen Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery, Leiden University Medical Center, the Netherlands

16. J. Sven D. Mieog corresponding Aachen Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery, Leiden University Medical Center, the Netherlands. Electronic address: j.s.d.mieog@lumc.nl

    Department of Surgery, Leiden University Medical Center, the Netherlands